For medical practices of every specialty
An independent revenue-cycle and operations review that drives out defects, not just finds them. We examine each part of your revenue cycle, size each finding in dollars and trace it to its root cause. Then we fix the cause and set the rules and checks once, so the same errors are caught before they come back.
Daily operations
A practice runs on many workflows at once: referrals, orders, scheduling, benefits, follow-up care, patient balances and more. Left loose, each one drifts in its own way, and the delays surface later in care, billing and communication. Give each workflow a clear structure, watch it every day, and the practice becomes efficient. We build the controls and custom software to do that for whichever workflows your practice runs. Revenue is what comes out when daily operations run well.
Each workflow is written down once: the steps, who owns each one, and the rules for what counts as done. Everyone works it the same way.
Each step hands off to the next in a set order, across roles and offices, so work doesn't wait for someone to notice it.
What has stalled, what is due and what is at risk comes up on each team's worklist, while it is still easy to fix.
A leadership view of the whole practice: what is on track, what has stalled and what is at risk, with when each was last refreshed. Rule-break trends sit alongside, so leadership can see where the process is slipping and whether fixes are holding.
Problems are seen early and decisions rest on current facts, without waiting for a report.
Examples, not a fixed list · every practice's workflows are its own
Incoming and outgoing referrals are tracked from the request to the referral on file. Visits still waiting on one, and requests that have gone quiet, come up well before the patient arrives.
Every physician order and prescription has a path from written to completed. One that stalls comes up with its next step and the person who owns it.
Routine paperwork is generated from data the practice already holds: school medication forms, prior authorization requests, referral letters and records requests. Supporting documentation, signatures and proof of delivery are captured before billing. Staff review and sign instead of retyping.
Follow-up visits, resupply and ongoing treatment each have a next due date. Patients who are due, overdue or starting to drift come up while a reminder can still help.
Upcoming appointments that show signs of a likely no-show are flagged early, so staff can confirm, remind or offer the time to another patient.
Coverage is checked ahead of each visit and checked again when it changes. A visit without a current check comes up before the patient arrives.
Open balances are matched to upcoming visits, so they can be raised kindly at check-in or followed up with a statement or a call.
If it repeats, it can be structured, watched and built for. Whatever your practice does over and over, from intake to inventory to follow-up, we can set its rules, build the controls and custom software around it, and put its exceptions on the morning worklist.
The same engine that keeps daily workflows moving also checks charges, coding, modifiers, payer setup and claims before anything goes out.
Rules are written once and owned by your practice, so a fix made once keeps holding.
Fewer rejections and denials, less rework, and causes fixed at the source.
The revenue half of every review covers insurance setup, claims, denials, payment posting and payer rates. Each finding is sized in dollars and traced to its root cause, so both halves are measured the same way.
Further readingStandardize Before You Improve (Institute for Healthcare Improvement) · Pre-Visit Planning: Save Time and Improve Care (AMA STEPS Forward) · What is workflow? (AHRQ Workflow Assessment for Health IT Toolkit)
What a review covers
A clinical review of systems checks each part of the body in order, so nothing is missed. We do the same for the business side of your practice, from the front desk to the month-end close.
Is the right insurance verified before care is delivered, with the right plan type on file?
Do payer records, plan types and fee schedules in your billing system match how payers actually pay?
How quickly do claims go out, and how many clear the clearinghouse on the first try?
Why payers say no, what it costs, and whether anyone is working the balance before it ages out.
Is money applied to the right claims, and are write-offs controlled by a policy?
Are payers paying what they usually pay, and what your contracts say they should?
Services
For medical practices of any specialty. Every service is built to drive out defects, not just report them: each problem is traced to its root cause, fixed there, and backed by a rule or check that keeps holding. Leadership gets clear numbers and the decisions that need them; your billing team gets the worklists and guides to act on them.
Before anything is built, we learn what your systems already hold and record where things stand today.
Fix the setup that every claim inherits. One corrected record stops the same error on every claim that would have used it.
One monthly package in plain billing-office language, with one headline number per section and simple charts.
Every denial reason, with its dollars, root cause and fix. We drive out the defect behind each one, so repeat denials stop at the source instead of being rebilled one by one.
Denials and Issues Build the RulesEach denial reason becomes a rule or check in the Rules Engine.
Work in a set order, logged the same way every time, so nothing ages without an owner.
Denials and Issues Build the RulesEach issue found in follow-up becomes a rule or check, so it is caught before the next claim goes out.
Checks that show whether the money in your reports is the money you actually have.
Finds money that should have arrived and didn't, or arrived and wasn't accounted for.
A baseline before any change, a monthly scorecard after, and recovered dollars counted claim by claim.
Where defects are driven out for good. Your practice's rules are built into daily worklists that sit alongside the systems your practice already uses, so a fix made once keeps holding. Monthly reports and worklists can refresh automatically. How it works
Denials and Issues Build the RulesIts rules come from your own denials and issues, found in the denial review and follow-up.
Receives totals, trends, benchmarks and decisions. Never claim-level lists.
Receives the claim-level detail, worklists and guides, kept on the practice's own systems.
The Rules Engine
Every practice already has its rules: get the referral before the visit, verify benefits before the order, keep units within the payer's limit. On a busy day, written procedures get skipped and staff notes get buried, and a denial follows weeks later. We build your rules into the software itself, as steps and checks that run on their own, so the right thing happens every time.
The Rules Engine is built to work alongside the systems your practice already uses: practice management, EHR, scheduling, billing, inventory and more. It checks your schedule, orders, charges and other data against your practice's rules and turns every exception into a daily worklist, so a problem is caught before the claim goes out, not after it comes back denied.
Denials and Issues Build the Rules.Every denial and every issue we find becomes a rule or check, so the defect is driven out instead of worked again.
Built for specialty practices and in daily use at a multi-location practice.
| Item | Rule | Status |
|---|---|---|
| New patient visit, Tue 9:40 | Referral on file before the visit | Overdue |
| Medication refill order | Prior authorization still current | Due today |
| Follow-up visit, Wed 2:15 | Benefits verified within 30 days | Due today |
| Charge review | Units within the payer's limit | Done · signed |
Referral, benefits, authorization and charge rules are written down once and owned by your practice. No sticky notes, no side spreadsheets. Staff come and go; the process remains, and a new hire works the same list on day one.
Each role and office sees its own worklist, overdue first, with a progress count leadership can read at a glance.
Who did what, and when. Exceptions need a supervisor's sign-off, and nothing is cleared in bulk.
After every refresh, the engine checks its counts against your system. If something doesn't match, it stops and says so instead of showing incomplete work.
No new EHR and no double entry. It reads from your existing system, and your data stays on your practice's own computers.
New rules are added as new denials and issues surface and as payers and policies change, and every list exports to Excel exactly as it appears on screen.
Approach
The same four steps for every practice, built to drive out defects rather than just list them. We start read-only, with the data your systems already hold, and nothing changes in your billing system until you approve it.
Data access, an inventory of every built-in report and export, and a baseline of where things stand today.
A system-by-system review. Each finding is defined, sourced, tied to a total, checked independently, sized in dollars and traced to its root cause.
Fix each root cause once you approve it: setup corrections, intake and pre-send checks, and rules built into the worklists, denial guide and follow-up routine your team works from every day.
The month-end package and scorecard on the same definitions every month, so you can see that fixes hold. Recovered dollars are counted only after a documented fix.
Discovery checklist
Standards
A finding is only useful if leadership can trust it. Every number we publish meets the same standard, and your patients' information never leaves your control.
We count recovered dollars only when a payment arrives after a documented fix, claim by claim. The biggest savings come from prevention: every denial driven out is a claim that never has to be worked again. An ounce of prevention is worth a pound of cure.
The baseline, scorecard and definitions stay the same every month, so progress is real and comparable.
What we look for
Lessons built into every review we run. Each one can hide money in plain sight.
Commercial carriers also sell Medicare Advantage and Medicaid plans. When one record covers several products, claims can go out with the wrong plan type. We audit per plan, not per company.
Outstanding-balance reports can book expected payments up front or apply filters you can't see. We rebuild A/R from claim balances, show credits on their own line and reconcile in dollars.
Virtual-card and paper payments have no 835 on file. We reconcile cash to the general ledger by month and explain every gap.
Clearing the clearinghouse is not the same as being paid by the payer, so a high acceptance rate can sit alongside a high denial rate. We measure both and keep one definition for each.
Each payer sets its own limit, and your contracts can override the published one. We check every unfiled claim against that payer's own limit, so the most urgent claims are worked first.
We compare each payment with that payer's usual rate for the same code, then check it against your contract before calling anything short.
Some exports stop at a fixed number of rows without saying so. A total that lands on a round number is a warning sign. We check every total against its source before anyone relies on it.
Engagements
Clear scope, clear fees. Amounts are set for each practice after a short conversation about size and goals.
Data access, report inventory, baseline and first findings, sized in dollars.
The leadership package and monthly scorecard, with the same definitions every month.
Questions outside the package, such as a payer contract review or a new service line.
Fuller rebuilds once complete data access is in place, and the Rules Engine set up for your practice and systems, with ongoing support as your rules change. Scope and structure are set case by case.
Every engagement starts read-only. We will ask for a business associate agreement before we handle any patient information.
Request a consultation
Tell us how your practice runs today: the workflows that slow you down, the billing that doesn't add up, and what you'd fix first. We'll come back with a clear scope and a fixed fee.